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DartmouthHitchcockMedicalCenter Lebanon,NewHampshire
CarolineWright,MBBS(Lond.),MS,FRACS
RPAInstititeofAcademicSurgery ConsultantSurgeon DepartmentofColorectalSurgery RoyalPrinceAlfredHospital NewSouthWales,Australia
OdedZmora,MD
AssociateProfessorofSurgery SacklerSchoolofMedicine TelAvivUniversity TelAviv,Israel Chair AssafHarofeMedicalCenter Zrifin,Israel
MassaratZutshi,MD,FACS
StaffSurgeonandAssociateProfessorofSurgery DepartmentofColorectalSurgery LernerCollegeofMedicineofCase
WesternReserveUniversity ClevelandClinicFoundation Cleveland,Ohio
W
ForewordtotheFirstEdition
eliveinahigh-technologyworldwherethe“miracles”ofmodern surgerymakeheadlinenewsaroundtheglobe.Itisnolonger
surprisingtohearofyetanotherstart-upmedicaltechnology companythatpromisesanewsurgicaldevicethatwillsavecountless lives,improveoutcomes,andsignificantlydecreasepainandsuffering. Peoplefindthemselvesmesmerizedbywatching“keyholesurgery” broadcastinhighdefinitiontotheirhometelevisionandfindit surprisinglyelegantandbloodlesscomparedwiththeirpriormental pictureofsurgeonsatwork.Soitisperhapsunderstandablethatmany patientstodaygoonlinetofindsurgeonsandinstitutionsofferingthe newestapproachesandlatesttechnology.Itseemsasthoughthemodern surgeonarmedwithhigh-techdevicesanddigitalizedequipmentshould beinvincible.Indeed,itiseasyforsurgeonstobeinappropriatelyswept upbythesirensongoftechnicalinnovation.
Inthiskindofworld,onemightquestiontheutilityofyetanother surgicaltextbook,especiallyonedevotedtooperativetechnique. Fortunately,editorsStevenWexnerandJamesFleshmanhavecreateda uniquepublicationthatisafarcryfromthetraditionaltextbookofthe past.Thelistofcontributingauthorsincludesseasonedmastersurgeons schooledintraditionaltechniquesandhighlyinnovativeresearchersand entrepreneurswhoareexploringnewfrontiersofsurgicaltechnology. Overthecourseoftheirbusyclinicalcareers,theeditorsthemselveshave successfullybridgedbothperspectives.Theiruniqueexperiencesare apparentinthisnew,tightlyeditedandhighlypracticaltextbookthat emphasizestriedandtrueopentechniquesandnew,lessinvasive techniques.
Drs.WexnerandFleshmanunderstandthatsurgicaloutcomesare dependentonmanyfactorsincludingclinicalacumenandmature judgmenttoguideindividualizeddecisionmaking.Buttheyalsoknow thatsurgeonsmustmasterbasicoperativeskillsanddevelopafull reservoirofdifferenttechniquesthatcanbeusedtofitthedemandsof thecaseathand.Asimportantly,theyknowthatnomatterhow revolutionaryorexciting,technologyhasitslimits.Innovationis providingnewtools,butitisthesurgeon’sskillindecidingwhattoolsto useandthewayinwhichtheyareusedthatdeterminesthesurgical outcome.Operativetechniqueremainscriticaltominimizepatient morbidity,curecancerandotherlife-threateningconditions,and preservefunctionandqualityoflife.Allcolonandrectalsurgeonswill findthisbooktobeavaluableadjuncttotheirpractice.Theartist’scolor drawingsaresuperbandanatomicallycorrect.Thetextiseasytoread,
veryfocused,andusefulforbusysurgeons.Icongratulatetheeditorsfor bringingthisbooktous.
DavidA.Rothenberger
August1,2011
S

Foreword

urgeryisbothanartandascience,andthereisnosubstitutefor acquiringbothknowledgeandskilltothehighestlevelforthebest
outcomesforourpatients.Whenwetalkaboutmasteringasubject, wemeanjustthis.Masterycomesfromrepeatingandrefininga procedureuntilitisasgoodaswecangetit.Inthisweneedthehelpand guidanceofmastersurgeons,andtheseexcellenttwovolumesprovide justthat.Inthissecondedition,thetechniqueshavebeenbroughtright uptodatewithstep-by-stepdescriptionsoftheessentialoperationsin colorectalsurgerybycarefullychosenexpertsintheirfield.Itislavishly illustrated,andthereisaccesstoacompanionwebsitewithanimage bankandvideosoftheprocedures.SteveWexnerandJimFleshmanhave doneagreatjobinrevisingandrenewingthisoutstandingcoupleof volumesintheMasterTechniquesseries.
NeilMortensen
Oxford,UnitedKingdom
August7,2017
T
PrefacetotheFirstEdition
heMasteryofColorectalSurgerytextbookisatwo-volume compendiumthatdemonstratesvirtuallyallofthecurrently
employedtechniquesforabdominalandanorectalsurgery.Allof thechaptershavebeenwrittenbyinternationallyacclaimedexperts,each ofwhomwasgivenliterarylicensetoallowthebooktobemorecreative andlessrigorouslyformatted.Althoughsometechniquesareself­explanatoryandtheauthorsthereforeconcentratedtheirverbiageupon resultsandcontroversiessurroundingaparticulartechnique,other proceduresaredescribedinamorealgorithmicmanner.Specifically, sometechniquesrequireamuchmoreheavilyweighteddescriptionof preoperativeand/orpostoperativeparametersratherthanintraoperative variables.Thematchingofillustrationsandvideoshasalsobeentailored tosuittheneedsofeachchapter.Becauseofthequantityofmaterial,the bookisdividedintotwovolumes:onethatincludestheabdominaland onethatincludesanorectalprocedures.Whilemanytextbooksvieforthe attentionofsurgeonsintrainingandsurgeonsinpractice,theMastery series,editedbyDr.JosefFischer,hasestablisheditselfastheresource forexpertmanagementofeachtheme.Therefore,thisbookwas deliberatelycraftedtoaugmentratherthantoreplaceseveralother excellentrecentlypublishedtextbooks.Itisourhopethatthesevolumes beusedinthatcontextsothatthereadercanlearnthefundamentalsand basicsusingmanyotherexcellentsourcematerialsandthenrelyupon theMasteryofColorectalSurgerybooksformoreclarityintermsof reviewofveryspecificprocedures.Inthatsamemanner,thesebooks performareadypreoperativeresourcebeforeembarkinguponindividual procedures.
WewishtothankJosefFischerforhavingentrusteduswiththislatest ofhisliteraryoffspring.Theprojecttookaconsiderableamountoftime andeffort,andwecertainlythankhimforhispatience.Inaddition,we thankourrespectivestaffinWestonandinSaintLouis,especiallyLiz Nordike,HeatherDean,Dr.FabioPotenti,andDebbieHoltonfortheir extensiveeffortsaswellasNicoleDernoskiatWoltersKluwer.Wewish toexpressoursincerestanddeepestgratitudetoeachandevery contributorfortheirtime,attention,expertise,andcommitmenttothe project.Withoutourindividualchapterauthors,thisworkwouldnot exist.Weknowthateachofthemhasmanysignificantcompeting obligationsfortheirlimitedtimeandthankthemforhavingparticipated tosuchanimportantdegreeinthisproject.Last,ourappreciationgoesto ourfamiliesfortheirloveandsupportasitisalwaystimeawayfrom themthatallowsustoproducethesetypeofbooks.Inparticular,
appreciationgoestoLindaFleshmanandtoWesleyandTrevorWexner.
StevenD.Wexner
JamesW.Fleshman
S

Preface

ixyearshaveelapsedsincewepublishedthetwovolumesofMaster TechniquesinGeneralSurgeryoncolorectalsurgeryincluding
anorectaloperationsandabdominaloperations.Contentwiththe overwhelmingpopularityofthatbook,wearepleasedandproudtooffer youthissecondedition.Weareindebtedtotheauthorsandcoauthorsof the117chaptersinthesetwovolumes.Wehopethatyouwillagreewith usthatthesetwovolumesprovidebeautifullyillustratedand authoritativelywrittenchaptersaboutvirtuallyeverycurrentlypracticed colorectalsurgicaltechnique.
Wehaveendeavoredtomakeeachchapterrelativelyfocusedrather thanbroadandtheauthorshave,asrequested,presentedclinically relevantmaterialthatcanbereadilydigested.Wehavedeliberately avoidedpublishingacomprehensivecompendiumabouteachsubject. Thus,manyareasareaddressedwithmultiplechapterseachofwhichhas itsownveryspecificviewandoffersclinicalguidanceonthebasisof practicalexpertise.Whilethepreferencesoftheauthorsvary,manyfacets withinthesetwovolumesarequiteconsistentincludingtheworld­renownednatureoftheauthorsandcoauthors,theconsistentlyhigh qualityoftheartwork,andthestyleofthechapters.Wehopethat readerswillagain,aswasthecasewiththefirstedition,findthesecond editionofthesetwovolumestobeanexcellentclinicalresourceoften consultedforbothpatientmanagementandacademicendeavors.
Weagainthanktheauthorsandcoauthorsofthese117chaptersfor theirtime,efforts,energy,expertise,andcooperationwiththeauthor guidelines,whichenabledustoofferyouthissecondedition.
StevenD.Wexner
JamesW.Fleshman

Contents

PARTI Hemorrhoidectomy
CHAPTER1
FergusonHemorrhoidectomy
AnthonyJ.Senagore
CHAPTER2
HemorrhoidectomyUsingaBipolarElectrothermalDevice(BED) andVibratory(Harmonic)Energy(VE)
WilliamC.Cirocco,GuyR.Orangio,KurtG.Davis,andSyedG. Husain
CHAPTER3
ProcedureforProlapsingHemorrhoids
JustinKellyandSamAtallah
CHAPTER4
Ultrasound-GuidedLigation/MucosalPexyforHemorrhoids
JosephT.GallagherandBethAnnShanker
CHAPTER5
RubberBandLigation
MitchellA.Bernstein,AlexisL.Grucela,andMichaelJ.Grieco
PARTII AnalFistula
CHAPTER6
Flaps(ExcisionandClosure,Mucosal,andSkin)
CarolineWrightandMichaelSolomon
CHAPTER7
FistulotomyandFistulectomy
ShotaTakanoandMaryliseBoutros
CHAPTER8
AnalFistulaPlug
BruceW.RobbandMarcA.Singer
CHAPTER9
LigationoftheIntersphinctericFistulaTract(LIFT):Updatewith Mesh
MarcC.Osborne
CHAPTER10
LigationoftheIntersphinctericFistulaTract(LIFT):Without Mesh
SyedG.HusainandAlanE.Harzman
PARTIII RectovaginalFistula
CHAPTER11
TransperinealApproach
G.WillyDavila
CHAPTER12
RectovaginalFistula:TransvaginalApproachwithBioprosthetic Mesh
H.DavidVargas
CHAPTER13
RectovaginalFistula:TransvaginalApproachwithoutMesh
AliceFrontaliandYvesPanis
CHAPTER14
RectovaginalFistula:TransanalRepairs
SheriefShawkiandMassaratZutshi
PARTIV OperationsforFecalIncontinence
CHAPTER15
OverlappingRepair
LaurenR.Wilson,TracyL.Hull,andBrookeGurland
CHAPTER16
MagneticAnalSphincter
PaulA.LehurandMiaKim
CHAPTER17
SacralNerveStimulation
KlausE.Matzel
PARTV PerinealProlapseRepair
CHAPTER18
DelormeProcedure
DeborahS.Keller,HemanM.Joshi,andC.RichardCohen
CHAPTER19
EncirclementProcedureforRectalProlapseintheElderly
WarrenE.LichliterandDeborahS.Keller